Hypertension may protect against cerebrovascular events after TAVI

27th September 2013

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Data from the Italian National Registry indicate that hypertension provides a protective effective against early cerebrovascular events after transcatheter aortic valve implantation (TAVI). The variable also shows a tendency to protect against late events

Presenting the data at PCR London Valves (15–17 September, London, UK), Federico De Marco (Ospedale Niguarda Ca’ Granda, Milan, Italy) said cerebral embolisation after TAVI was “a common finding”, adding: “The rate of major stroke one year after TAVI was 3.8% in cohort A of the PARTNER study.” He reported that the aim of the present study was to determine the incidence and timing, and predictors, of “clinically evident stroke after TAVI with CoreValve (Medtronic) in the Clinical Service population (formally, the Italian CoreValve Registry).”

Data were prospectively collected from patients undergoing TAVI with the CoreValve device in seven high-volume Italian centres between June 2007 and December 2012. Of the 1,320 patients who received a CoreValve during this time, there were 50 cerebrovascular events—37 were strokes (all ischaemic) and 13 were transient ischaemic attacks. There was no prospective distinction between major and minor strokes. De Marco reported that a quarter of events were acute and that all events (acute, subacute, or late) had a significant effect on both all-cause mortality and cardiovascular death.

De Marco said: “In a univariable analysis, the most important predictors of cerebrovascular events after TAVI were hypertension and coronary artery disease. Interestingly, both of these factors were also preventative. We also looked at the procedural variables and, contrary to what has been seen previously, valve-in-valve and postdilation did not have an effect on the rate of cerebrovascular events.” According to De Marco, the protective effects of hypertension were also apparent when they looked at the rate of stroke alone. “At 30 days, in a multivariate analysis, we saw that hypertension was an independent protective factor for cerebrovascular events and also for stroke alone while new-onset atrial fibrillation was an independent predictor for stroke,” he added.

Looking into the reasons why hypertension provided a protective effect, De Marco et al found that hypertensive patients were more likely to be female, have New York Heart Association (NYHA) heart failure class 3–4, be on aspirin before admission, be on dual antiplatelet therapy before admission, and have a higher CHADS2 risk score than patients without hypertension. However, the authors did not find anything that would explain the apparent protective effect of hypertension.

De Marco summarised the results of the study by saying: “Hypertension appeared as a protective variable on early events and showed a tendency to protect from late events too.”